Individual
KEITH KIRIMI NDEGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5225 23RD AVE SOUTH, FARGO, ND 58104
(701) 417-3400
Mailing address
5357 27TH ST SOUTH, APT 110, FARGO, ND 58104
(701) 781-7573
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA.0014512
CO
Other
Enumeration date
04/22/2019
Last updated
04/22/2019
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